Purpose To study the morphology of the gyri and sulci of the insular region. Materials and method... more Purpose To study the morphology of the gyri and sulci of the insular region. Materials and methods This study examined 20 formalin-fixed cerebral hemispheres (10 right and 10 left). Observations described: the peri-insular sulci, anatomical variations in the insular sulci and gyri, and the relationships between the central insular sulcus and the central cerebral sulcus and the anatomy of the insular arteries. Results Each insula had a trapezoid shape, surrounded by four peri-insular sulci (anterior, superior, posterior, and inferior). We differentiated the posterior peri-insular sulcus from the inferior peri-insular sulcus. These two sulci have two different axes separated by a clear angle. The central insular sulcus divides the insula into two parts. The anterior insula includes three short gyri and the anterior insular pole. The posterior insula includes two long gyri and the posterior insular pole. This structure defines two intra-insular opercula. In 60% of cases, the superior extremity of the central insular sulcus is in direct continuity with the inferior extremity of the cerebral central sulcus. The superior branch of the middle cerebral artery supplies the majority of the anterior insular gyri, and the inferior branch supplies the majority of the posterior insular gyri. Conclusions This study details the morphology of each insular structure (gyri, sulci and poles), data which could facilitate surgical access to this deep cortical area and assist in future work correlating anatomy with function.
The volatile constituents of Vitex pseudo-negundo (Hausskn.) Hand.-Mzt. were isolated by hydrodis... more The volatile constituents of Vitex pseudo-negundo (Hausskn.) Hand.-Mzt. were isolated by hydrodistillation and analyzed via GC and GC/MS. The major constituents of the leaf oil were α-pinene (35.9%), limonene (12.2%) and bicyclogermacrene (9.5%), while the fruit oil contained α-pinene (31.7%), bicyclogermacrene (14.5%) and limonene (11.5%), and the fower oil contained α-pinene (14.7%), bicyclogermacrene (8.3%) and limonene (5.8%).
Different lines of evidence have suggested an involvement of the insular cortex in pain processin... more Different lines of evidence have suggested an involvement of the insular cortex in pain processing. Direct electrical stimulation (ES) of the human insular cortex during surgical procedure sometimes induces painful sensations and painful stimuli induce activation of the insular cortex as shown by functional neuroimaging. Invasive evaluation of epileptic patients by deep brain stereotactically implanted electrodes provides an opportunity to analyze responses induced by ES of the insular cortex in awake and fully conscious patients. For this study, we included 25 patients suffering from drug refractory focal epilepsy with at least one electrode stereotactically implanted in the insular cortex using an oblique approach (transfrontal or transparietal). Out of the 83 responses induced by insular ES, eight (9.6%) were reported by five patients as painful sensations. Four were restricted to the cephalic region and four were felt on the ipsilateral or bilateral upper limbs, the shoulders and the trunk (pinprick sensations). The eight stimulation sites were anatomically localized via image fusion between pre-implantation 3D MRI and post-implantation 3D CT scans revealing the electrode contacts. All sites inducing painful sensations were restricted to the upper portion of the middle short gyrus of the insula. The findings of this study suggest that middle short gyrus is involved in the processing of pain-producing stimuli.
lésions expérimentales chez le rat sous le nom d'autotomie. Ces comportements sont en relation av... more lésions expérimentales chez le rat sous le nom d'autotomie. Ces comportements sont en relation avec la douleur et non la déafférentation sensitive elle-même, comme montré expérimentalement ; en effet, les lésions d'autotomie, qui se développent après radicotomie dorsale, disparaissent après DREZotomie (c'està-dire destruction des neurones de la corne dorsale). Matériel-méthode.-Dans notre série de 85 patients, ces comportements se manifestaient par : -fréquemment, des menaces verbales de se mutiler ou de se faire amputer, -parfois, des lacérations cutanées, -plus rarement, des tentatives (plus ou moins poussées) de destruction du membre : comme sciage du bras (chez l'un de nos patients) ou tir d'une balle dans la main douloureuse (chez un autre de nos patients). Résultats ou cas rapporté.-La DREZotomie cervicale a permis la guérison des douleurs de ces deux patients où l'automutilation avait été sévère. Dans les formes mineures de lacération ou avec simples menaces verbales, la guérison des douleurs (obtenue dans les deux tiers des cas) a fait cesser ces comportements.
This study investigates the feasibility, safety, and usefulness of depth electrodes stereotactica... more This study investigates the feasibility, safety, and usefulness of depth electrodes stereotactically implanted within the insular cortex. Thirty patients with suspected insular involvement during epileptic seizure underwent presurgical stereotactic electroencephalographic recordings using 10 to 16 depth electrodes per patient. Among these, one or two electrodes were implanted via an oblique approach to widely sample the insular cortex. Thirty-five insular electrodes were implanted in the 30 patients without morbidity. A total of 226 recording contacts (mean, 7.5 contacts/patient) explored the insular cortex. Stereotactic electroencephalographic recordings of seizures allowed the differentiation into groups: Group 1, 10 patients with no insular involvement; Group 2, 15 patients with secondary insular involvement; and Group 3, five patients with an initial insular involvement. In temporal epilepsy (n = 17), the insula was never involved at the seizure onset but was frequently involved during the seizures (11 out of 17). In frontotemporal or frontal epilepsy, the insula was involved at the onset of seizure in five out of 13 patients. All patients in Groups 1 and 2 underwent surgery, with a seizure-free outcome in 76.2% of patients. In Group 3, only two of the five patients underwent surgery, with a poor outcome. In temporal lobe epilepsy, surgical outcome tended to be better in Group 1 compared with Group 2 in this small series: results were good in 83.3% (Engel I) versus 72.7%. Insula can be safely explored with oblique electrodes. In temporal lobe epilepsy, insular involvement does not significantly modify the short-term postoperative outcome. Future larger studies are necessary to clarify the long-term prognostic value of insular spread.
A. Afif). But de l'étude.-Proposer un schéma proportionnel original de la région insulaire dans l... more A. Afif). But de l'étude.-Proposer un schéma proportionnel original de la région insulaire dans le référentiel Commissure Antérieure-Commissure Postérieure (CA-CP). Matériel et méthodes.-Étude morphométrique en IRM de l'anatomie gyrale et sulcale de l'insula à partir de 75 schémas individuels (38 G et 37 Dt) de régions insulaires normales Intégration et formatage dans le repère CA-CP de chaque schéma. Superpositions et moyennages informatiques des données en 2D dans le logiciel MATLAB
Introduction.-Ce projet a pour but de réaliser un modèle chronique de stimulation du cortex moteu... more Introduction.-Ce projet a pour but de réaliser un modèle chronique de stimulation du cortex moteur (CM) chez le chat pour mieux comprendre les mécanismes d'action et optimiser cette technique à visée antalgique, utilisée chez l'Homme dans le traitement des douleurs neuropathiques réfractaires. Matériel -méthode.-En conditions stéréotaxiques et après craniotomie, une cartographie du CM est établie par stimulation bipolaire chez 10 chats. Les réponses motrices sont repérées par observation et palpation des muscles concernés. Résultats ou cas rapporté.-Le CM de nos 10 chats présente très peu de variations de ses coordonnées stéréotaxiques. Il n'y a aucun effet significatif du côté de stimulation (droit, gauche) ni du type de stimulation (extradurale, intradurale) sur la cartographie du CM. Les seuils de réponse musculaire, dépendent significativement du Type de stimulation et de la Région corticale concernée et sont indépendants du côté. La patte antérieure représente la plus grande surface corticale, suivie de la patte postérieure, de la face et enfin du tronc. Conclusion.-La cartographie du CM chez le chat est indépendante de la situation de la stimulation (extra-ou intradurale). Les seuils de stimulation dépendent de la situation extra-ou intradurale et de la région corticale stimulée. Les régions corticales contrôlant les pattes antérieures se situent latéralement dans le CM par rapport à celles contrôlant les pattes postérieures. Les coordonnées stéréotaxiques des limites de ce CM ainsi que de ses différentes régions présentent très peu de variabilité interindividuelle, ce qui guidera l'implantation de l'électrode de stimulation du CM dans la suite de ce projet. Le sillon crucié, situé au sein du CM, constitue un repère constant avec peu de variabilité intersujet. En revanche, le sillon postcrucié, inconstant (80 % des cas) et variable, pourrait correspondre à une ébauche du sillon central chez l'Homme incomplètement creusé chez le chat.
To describe the morphological stages of insular sulci and gyri development we carried out a macro... more To describe the morphological stages of insular sulci and gyri development we carried out a macroscopical study on 21 human fetal brains, showing no anomalies, from 13 to 28 gestational weeks (GWs). Particular focus was given to morphological appearance during the development of insular and periinsular structures, especially the gyration and sulcation of the insula, central cerebral region and opercula, as well as the vascularization of these regions. The periinsular sulci and the central (insular and cerebral) sulci were the first macroscopical structures identified on the lateral surface of the human fetal cerebral hemisphere with earlier development on the right hemisphere. Here we describe five stages of insular gyral and sulcal development closely related to gestational age: stage 1: appearance of the first sulcus at 13-17 GWs, stage 2: development of the periinsular sulci at 18–19 GWs, stage 3: central sulci and opercularization of the insula at 20–22 GWs, stage 4: covering of the posterior insula at 24–26 GWs, stage 5: closure of the sylvian fissure at 27–28 GWs. We provide evidence that cortical maturation (sulcation and gyration) and vascularization of the lateral surface of the brain starts with the insular region, suggesting that this region is a central area of cortical development.
to the classical AC-PC stereotactic reference system. They furthermore allow us to quantify the p... more to the classical AC-PC stereotactic reference system. They furthermore allow us to quantify the probability that a given element of this structure is located at a predefined position. This should be useful in functional neuroimaging studies and in insular surgery for diagnostic and therapeutic goals.
Purpose: Different lines of evidence have suggested an involvement of the insular cortex in spee... more Purpose: Different lines of evidence have suggested an involvement of the insular cortex in speech production. These have included results from lesion studies, functional imaging techniques, and electrical stimulation of the human insular cortex during invasive evaluation of epileptic patients.Methods: We evaluated 25 patients who had drug refractory focal epilepsy with at least one electrode stereotactically implanted in the insular cortex.Results: Eight responses to insular cortex electrical stimulation were reported by five patients as speech arrest (five responses) and a lowering of voice intensity (three responses).Conclusions: Data from this study implicate the middle short gyrus of the insula in the production of speech and show the importance of intrainsular electrode implantation during invasive pre-resection evaluation by stereo-electroencephalography (SEEG) when speech arrest occurs early in seizure semiology.
Purpose To study the morphology of the gyri and sulci of the insular region. Materials and method... more Purpose To study the morphology of the gyri and sulci of the insular region. Materials and methods This study examined 20 formalin-fixed cerebral hemispheres (10 right and 10 left). Observations described: the peri-insular sulci, anatomical variations in the insular sulci and gyri, and the relationships between the central insular sulcus and the central cerebral sulcus and the anatomy of the insular arteries. Results Each insula had a trapezoid shape, surrounded by four peri-insular sulci (anterior, superior, posterior, and inferior). We differentiated the posterior peri-insular sulcus from the inferior peri-insular sulcus. These two sulci have two different axes separated by a clear angle. The central insular sulcus divides the insula into two parts. The anterior insula includes three short gyri and the anterior insular pole. The posterior insula includes two long gyri and the posterior insular pole. This structure defines two intra-insular opercula. In 60% of cases, the superior extremity of the central insular sulcus is in direct continuity with the inferior extremity of the cerebral central sulcus. The superior branch of the middle cerebral artery supplies the majority of the anterior insular gyri, and the inferior branch supplies the majority of the posterior insular gyri. Conclusions This study details the morphology of each insular structure (gyri, sulci and poles), data which could facilitate surgical access to this deep cortical area and assist in future work correlating anatomy with function.
The volatile constituents of Vitex pseudo-negundo (Hausskn.) Hand.-Mzt. were isolated by hydrodis... more The volatile constituents of Vitex pseudo-negundo (Hausskn.) Hand.-Mzt. were isolated by hydrodistillation and analyzed via GC and GC/MS. The major constituents of the leaf oil were α-pinene (35.9%), limonene (12.2%) and bicyclogermacrene (9.5%), while the fruit oil contained α-pinene (31.7%), bicyclogermacrene (14.5%) and limonene (11.5%), and the fower oil contained α-pinene (14.7%), bicyclogermacrene (8.3%) and limonene (5.8%).
Different lines of evidence have suggested an involvement of the insular cortex in pain processin... more Different lines of evidence have suggested an involvement of the insular cortex in pain processing. Direct electrical stimulation (ES) of the human insular cortex during surgical procedure sometimes induces painful sensations and painful stimuli induce activation of the insular cortex as shown by functional neuroimaging. Invasive evaluation of epileptic patients by deep brain stereotactically implanted electrodes provides an opportunity to analyze responses induced by ES of the insular cortex in awake and fully conscious patients. For this study, we included 25 patients suffering from drug refractory focal epilepsy with at least one electrode stereotactically implanted in the insular cortex using an oblique approach (transfrontal or transparietal). Out of the 83 responses induced by insular ES, eight (9.6%) were reported by five patients as painful sensations. Four were restricted to the cephalic region and four were felt on the ipsilateral or bilateral upper limbs, the shoulders and the trunk (pinprick sensations). The eight stimulation sites were anatomically localized via image fusion between pre-implantation 3D MRI and post-implantation 3D CT scans revealing the electrode contacts. All sites inducing painful sensations were restricted to the upper portion of the middle short gyrus of the insula. The findings of this study suggest that middle short gyrus is involved in the processing of pain-producing stimuli.
lésions expérimentales chez le rat sous le nom d'autotomie. Ces comportements sont en relation av... more lésions expérimentales chez le rat sous le nom d'autotomie. Ces comportements sont en relation avec la douleur et non la déafférentation sensitive elle-même, comme montré expérimentalement ; en effet, les lésions d'autotomie, qui se développent après radicotomie dorsale, disparaissent après DREZotomie (c'està-dire destruction des neurones de la corne dorsale). Matériel-méthode.-Dans notre série de 85 patients, ces comportements se manifestaient par : -fréquemment, des menaces verbales de se mutiler ou de se faire amputer, -parfois, des lacérations cutanées, -plus rarement, des tentatives (plus ou moins poussées) de destruction du membre : comme sciage du bras (chez l'un de nos patients) ou tir d'une balle dans la main douloureuse (chez un autre de nos patients). Résultats ou cas rapporté.-La DREZotomie cervicale a permis la guérison des douleurs de ces deux patients où l'automutilation avait été sévère. Dans les formes mineures de lacération ou avec simples menaces verbales, la guérison des douleurs (obtenue dans les deux tiers des cas) a fait cesser ces comportements.
This study investigates the feasibility, safety, and usefulness of depth electrodes stereotactica... more This study investigates the feasibility, safety, and usefulness of depth electrodes stereotactically implanted within the insular cortex. Thirty patients with suspected insular involvement during epileptic seizure underwent presurgical stereotactic electroencephalographic recordings using 10 to 16 depth electrodes per patient. Among these, one or two electrodes were implanted via an oblique approach to widely sample the insular cortex. Thirty-five insular electrodes were implanted in the 30 patients without morbidity. A total of 226 recording contacts (mean, 7.5 contacts/patient) explored the insular cortex. Stereotactic electroencephalographic recordings of seizures allowed the differentiation into groups: Group 1, 10 patients with no insular involvement; Group 2, 15 patients with secondary insular involvement; and Group 3, five patients with an initial insular involvement. In temporal epilepsy (n = 17), the insula was never involved at the seizure onset but was frequently involved during the seizures (11 out of 17). In frontotemporal or frontal epilepsy, the insula was involved at the onset of seizure in five out of 13 patients. All patients in Groups 1 and 2 underwent surgery, with a seizure-free outcome in 76.2% of patients. In Group 3, only two of the five patients underwent surgery, with a poor outcome. In temporal lobe epilepsy, surgical outcome tended to be better in Group 1 compared with Group 2 in this small series: results were good in 83.3% (Engel I) versus 72.7%. Insula can be safely explored with oblique electrodes. In temporal lobe epilepsy, insular involvement does not significantly modify the short-term postoperative outcome. Future larger studies are necessary to clarify the long-term prognostic value of insular spread.
A. Afif). But de l'étude.-Proposer un schéma proportionnel original de la région insulaire dans l... more A. Afif). But de l'étude.-Proposer un schéma proportionnel original de la région insulaire dans le référentiel Commissure Antérieure-Commissure Postérieure (CA-CP). Matériel et méthodes.-Étude morphométrique en IRM de l'anatomie gyrale et sulcale de l'insula à partir de 75 schémas individuels (38 G et 37 Dt) de régions insulaires normales Intégration et formatage dans le repère CA-CP de chaque schéma. Superpositions et moyennages informatiques des données en 2D dans le logiciel MATLAB
Introduction.-Ce projet a pour but de réaliser un modèle chronique de stimulation du cortex moteu... more Introduction.-Ce projet a pour but de réaliser un modèle chronique de stimulation du cortex moteur (CM) chez le chat pour mieux comprendre les mécanismes d'action et optimiser cette technique à visée antalgique, utilisée chez l'Homme dans le traitement des douleurs neuropathiques réfractaires. Matériel -méthode.-En conditions stéréotaxiques et après craniotomie, une cartographie du CM est établie par stimulation bipolaire chez 10 chats. Les réponses motrices sont repérées par observation et palpation des muscles concernés. Résultats ou cas rapporté.-Le CM de nos 10 chats présente très peu de variations de ses coordonnées stéréotaxiques. Il n'y a aucun effet significatif du côté de stimulation (droit, gauche) ni du type de stimulation (extradurale, intradurale) sur la cartographie du CM. Les seuils de réponse musculaire, dépendent significativement du Type de stimulation et de la Région corticale concernée et sont indépendants du côté. La patte antérieure représente la plus grande surface corticale, suivie de la patte postérieure, de la face et enfin du tronc. Conclusion.-La cartographie du CM chez le chat est indépendante de la situation de la stimulation (extra-ou intradurale). Les seuils de stimulation dépendent de la situation extra-ou intradurale et de la région corticale stimulée. Les régions corticales contrôlant les pattes antérieures se situent latéralement dans le CM par rapport à celles contrôlant les pattes postérieures. Les coordonnées stéréotaxiques des limites de ce CM ainsi que de ses différentes régions présentent très peu de variabilité interindividuelle, ce qui guidera l'implantation de l'électrode de stimulation du CM dans la suite de ce projet. Le sillon crucié, situé au sein du CM, constitue un repère constant avec peu de variabilité intersujet. En revanche, le sillon postcrucié, inconstant (80 % des cas) et variable, pourrait correspondre à une ébauche du sillon central chez l'Homme incomplètement creusé chez le chat.
To describe the morphological stages of insular sulci and gyri development we carried out a macro... more To describe the morphological stages of insular sulci and gyri development we carried out a macroscopical study on 21 human fetal brains, showing no anomalies, from 13 to 28 gestational weeks (GWs). Particular focus was given to morphological appearance during the development of insular and periinsular structures, especially the gyration and sulcation of the insula, central cerebral region and opercula, as well as the vascularization of these regions. The periinsular sulci and the central (insular and cerebral) sulci were the first macroscopical structures identified on the lateral surface of the human fetal cerebral hemisphere with earlier development on the right hemisphere. Here we describe five stages of insular gyral and sulcal development closely related to gestational age: stage 1: appearance of the first sulcus at 13-17 GWs, stage 2: development of the periinsular sulci at 18–19 GWs, stage 3: central sulci and opercularization of the insula at 20–22 GWs, stage 4: covering of the posterior insula at 24–26 GWs, stage 5: closure of the sylvian fissure at 27–28 GWs. We provide evidence that cortical maturation (sulcation and gyration) and vascularization of the lateral surface of the brain starts with the insular region, suggesting that this region is a central area of cortical development.
to the classical AC-PC stereotactic reference system. They furthermore allow us to quantify the p... more to the classical AC-PC stereotactic reference system. They furthermore allow us to quantify the probability that a given element of this structure is located at a predefined position. This should be useful in functional neuroimaging studies and in insular surgery for diagnostic and therapeutic goals.
Purpose: Different lines of evidence have suggested an involvement of the insular cortex in spee... more Purpose: Different lines of evidence have suggested an involvement of the insular cortex in speech production. These have included results from lesion studies, functional imaging techniques, and electrical stimulation of the human insular cortex during invasive evaluation of epileptic patients.Methods: We evaluated 25 patients who had drug refractory focal epilepsy with at least one electrode stereotactically implanted in the insular cortex.Results: Eight responses to insular cortex electrical stimulation were reported by five patients as speech arrest (five responses) and a lowering of voice intensity (three responses).Conclusions: Data from this study implicate the middle short gyrus of the insula in the production of speech and show the importance of intrainsular electrode implantation during invasive pre-resection evaluation by stereo-electroencephalography (SEEG) when speech arrest occurs early in seizure semiology.
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